PICTURE OF ORAL HEALTH 2016 - Cardiff University€¦ · ©Cardiff University, February 2016 . 3 Summary The 2014/15 dental survey of five year olds shows a further 6% reduction in

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PICTURE OF ORAL HEALTH 2016

DENTAL EPIDEMIOLOGICAL SURVEY

OF 5 YEAR OLDS 2014/15

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Contents

Page Number

Summary

Introduction

Preventable Decay in Wales

Preventable Decay in Local Health Boards

Preventable Decay in Unitary Authorities

Active Decay in Wales

Active Decay in Local Health Boards

Active Decay in Unitary Authorities

Designed to Smile Impact

Appendices

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4

4

7

9

10

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Authors

Maria Morgan, Senior Lecturer, Welsh Oral Health Information Unit, Cardiff University.

Nigel Monaghan, Honorary Senior Lecturer, Cardiff University.

http://www.cardiff.ac.uk/dentl/research/themes/appliedclinicalresearch/

epidemiology/oralhealth/index.html

©Cardiff University, February 2016

http://www.cardiff.ac.uk/dentl/research/themes/appliedclinicalresearch/epidemiology/oralhealth/index.html


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Summary

The 2014/15 dental survey of five year olds shows a further 6% reduction in the proportion

of children with experience of dental decay in Wales when compared with the previous

survey undertaken in 2011/12 (41.4% falling to 35.4%). In the eight years since 2007/8 this

demonstrates a 12% reduction in the proportion of children with at least one tooth affected

by decay (from 47.6%).

This is mirrored by a similar statistically significant reduction in all Wales mean decay

experience (average number of decayed, missing and filled teeth per child) from 1.98 in

2007/08 to 1.29 in 2014/15. These improvements in oral health mainly reflect steady

improvements in most areas of Wales.

Dental disease levels in children in Wales continue to improve across all social groups.

There is no evidence of widening inequalities here. This is in contrast with surveys prior to

2007 when improved decay levels were normally associated with widening inequality.

The Designed to Smile programme was in the early stages of implementation for under 5’s

in many areas of Wales until 2012. As a result, some of the children surveyed in 2014/15

attending schools eligible to participate in Designed to Smile may not have yet received the

full benefits of this programme.

Analyses in this survey confirm that schools which have been targeted for the Designed to

Smile Programme currently have greater baseline levels of dental disease. This is to be

expected as they were targeted because of historically high disease levels associated with

material deprivation.

Early data analyses suggest that dmft in children attending Designed to Smile schools is

improving. When five year olds survey results for 2015/16 are available the full impact of

Designed to Smile should be emerging.

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Introduction

This document presents data from a dental survey of school year 1 children (approximately

5-years of age) undertaken in Wales between September 2014 and April 2015, as a part of

the NHS dental survey programme.

This summary report will be complemented by data tables which will be available on the

Welsh Oral Health Information Unit website shortly after publication of this report.

Information relating interpretation of data collected in the past for surveys of this age group

are outlined in the Appendix.

Preventable Decay in Wales

The sum of decayed, missing and filled teeth is a measure of the decay experience of the

average child. It is therefore the burden of disease which theoretically could have been

prevented and thus key data for evaluation of efforts to prevent decay.

Figure 1 shows the trend in the mean number of decayed, missing and filled teeth per child

in Wales. Between 2007/08 and 2011/12 there was a reduction in dmft from 1.98 to 1.59. In

2014/5 we saw a further reduction to 1.29. This represents a 35% reduction in mean dmft

scores in 8 years.

Figure 1 Trend in mean dmft for Wales 2007/08 – 2014/15

See Appendices 2, 3 & 4 for data

Not all of the children examined had decay. Figure 2 shows a reduction in the proportion of

children with decay between 2007/08 (47.6%), 2011/12 (41.4%) and 2014/15 (35.4%). This

represents continuing improvement of the proportion of children who have no obvious

decay experience by age 5. Thus in 2015 in a class of 30 children about 19 will have no decay

experience compared with 16 in 2008.


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Figure 2 Percentage of children in Wales with caries (%dmft>0) 2007/08 –

2014/15


Data on those children who have at least 1 decayed, missing or filled tooth starts to

illustrate the stark differences between the children with decay and those without. Mean

dmft for a child with at least one tooth so affected is shown in Figure 3. The continuing

reduction from 4.16 in 2007/8 to 3.85 in 2011/2012 and now to 3.63 in 2014/5 is statistically

and clinically significant. This represents one tooth fewer affected by decay among every 2

children with decay experience.

Figure 3 Mean dmft of children in Wales with decay experience (mean dmft

where dmft>0) 2007/08 – 2014/15


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Figure 4 Inequalities in mean number of decayed teeth (dmft) in Welsh

children, 2007/08 – 2014/15

Figures 4 and 5 illustrate the relationship between dmft and the Welsh Index of Multiple

Deprivation (WIMD). Mean dmft and the %dmft>0 for all quintiles of deprivation have

fallen in 2014/15 when compared with values for 2011/12. This improvement across all

quintiles of deprivation is impressive given the impact of a global economic downturn.

Decay is higher is poorer communities across the globe and would be expected to either rise

or show little improvement in hard times.

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Figure 5 % of children in Wales with decay by Welsh Index of Multiple

Deprivation (%dmft>0), 2007/08 – 2014/15

Preventable Decay in Local Health Boards

Local Health Board (LHB) mean dmft scores for 2007/08 until 2014/15 are presented in

Figure 6 and have shown statistically significant reductions over 8 years in all LHBs except

Cwm Taf and Powys. The mean dmft in 2014/15 ranged from 0.90 in Hywel Dda to 1.77 in

Cwm Taf.

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Figure 6 Mean dmft per 5 year old by LHB, 2007/08 – 2014/15


Figure 7 illustrates the proportion of children with at least 1 decayed tooth (%dmft>0) by

LHB between 2007/08 and 2014/15.

Figure 7 Percentage with caries (%dmft>0) among 5 year olds by LHB, 2007/08

– 2014/15


Again that have been statistically significant reductions in this index for all LHBs, except

Cwm Taf, ABMU and Powys. For the latter two LHBs there were reductions which were not

statistically significant with the sample size used for these surveys. In 2014/15 the

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percentage of children with caries experience ranged from 24.9% in Cardiff and Vale to

46.3% in Cwm Taf.

Figure 8 Mean dmft of those with decay experience (mean dmft where

dmft>0) by LHB, 2007/08 – 2014/15


Figure 8 presents the average number (from 1 to 20) of decayed teeth for children with

some decay, i.e. mean dmft of those with dmft. In 2014/15 this ranged from 3.32 in Hywel

Dda to 3.86 in Aneurin Bevan.

As more children are rendered caries free, this index could fall, stay the same or rise

depending on decay trends among those most at risk of decay. The reduction at an all Wales

level for this characteristic (Figure 3) reflects reductions across all LHBs which only reach

statistical significance in ABMU and Hywel Dda. Overall in Wales, those at most risk of decay

are experiencing decreasing numbers of teeth affected.

Preventable Decay in Unitary Authorities

As Unitary Authorities have smaller populations than LHBs the sample size for the survey is

smaller and findings from the survey are therefore less likely to demonstrate statistically

significant changes.

The mean dmft by Unitary Authority is shown in Appendix 1 for each region of Wales for

2007/08, 2011/12 and 2014/5. Statistically significance reductions in preventable decay

were seen in 10 of the 22 Unitary Authorities.

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Wider UK Data

At the time of drafting this report wider UK data for mean dmft for 2014/2015 is not

available. In due course access to this data should be available via links on the British

Association for the Study of Community Dentistry website.

Active Decay in Wales

The decayed teeth (dt) component measures decay which the examining dentist believes to

be actively progressing. Active decay puts the child at risk of pain, infection and suggests risk

of decay of permanent successor teeth. Decayed teeth data (dt) is a marker indicating

children with current need for support in managing this chronic dental disease.

All Wales

Figure 9 shows the trend in the mean number of decayed teeth per child in Wales. Between

2007/08 and 2014/15 there has been a continuing reduction in dt from 1.40 to 0.88.

Figure 9 Mean number of decayed teeth (dt) per child in Wales, 2007/08 –

2014/15


Active Decay in Local Health Boards

Mean dt scores between 2007/08 and 2014/15 are presented in Figure 10. Over the 8 year

period there have been statistically significant reductions in all LHBs except Cwm Taf and

Powys. In 2014/15 mean dt ranged from 0.59 in Cardiff and Vale to 1.17 in Aneurin Bevan

LHB.

http://www.bascd.org/oral-health-surveys


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Figure 10 Mean decayed teeth per child by Local Health Board (dt), 2007/08 –

2014/15


Active Decay in Unitary Authorities

Decayed teeth data at unitary Authority level is included in appendices 2 for 2014/15, 3 for 2011/12 and 4 for 2007/8. Caries experience does not follow a bell shaped distribution curve, many children have only one or two decayed teeth. If fewer children present with one or two decayed teeth can push up the mean caries experience of the remaining children with decay experience. Between 2007/08 and 2014/15 there have been reductions in mean dmft averaging 0.69 across Wales. In 18 unitary authority areas the improvement was in the range of 0.22-1.42 decayed, missing or filled teeth per child. In 4 unitary authorities the improvement was below 0.2 dmft.

Wider UK data

At the time of drafting this report wider UK data on active decay for 2014/2015 is not

available. In due course access to this data should be available via links on the British

Association for the Study of Community Dentistry website.

Designed to Smile Impact

Designed to Smile is the National Oral Health Programme for Wales. This is a targeted oral

health promotion programme which is focussed on preventing dental decay in children in

pre-school and primary school settings. Work to roll the programme out across the whole

of Wales was commenced in 2010. Further information is available from the Welsh Oral

Health Information Unit.





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Over the last 3 surveys samples included 5 year old children from schools involved in the

initial Designed to Smile pilot and from schools that are now being included in the Designed

to Smile programme as it is rolled out. It also surveyed children who are not taking part in

Designed to Smile. These surveys were not specifically designed to evaluate Designed to

Smile, however D2S should impact on these indicators because of the scale of the D2S

programme.

Schools Involved in Designed to Smile Programme

Tables 1 and 2 illustrate the proportion of schools and children which are now participating

(or not) in Designed to Smile which were randomly sampled in the surveys between

2007/08 and 2014/15.

Table 1 Number of schools surveyed, by participation in D2S, 2007/08 – 2014/15

Table 2 Number of children examined, by survey year and participation in D2S

Mean dmft in schools selected for inclusion in the Designed to Smile programme is greater

than for the schools which have not been involved in the programme (Figure 11). Similarly,

there is a larger proportion of children with decay experience (%dmft>0) attending schools

now participating in Designed to Smile (Figure 12). This confirms that the programme is

being targeted at schools with greater disease experience.

Since 2008, mean dmft has reduced in all schools. The reduction in mean dmft is slightly

greater in Designed to Smile Schools. A similar improvement pattern is seen in the

proportion of children with experience of decay (%dmft>0, Figure 12).

Epidemiology

survey year

Taking part in

D2S now

Not taking part

in D2S nowAll

2007-08 305 320 625 48.8

2011-12 291 325 616 47.2

2014-15 293 228 521 56.2

% taking

part in

D2S

Number of schools participating in dental

survey

Epidemiology

survey year

Taking part in

D2S

Not taking part

in D2SAll

2007-08 3641 3459 7100 51.3

2011-12 3891 3843 7734 50.3

2014-15 4181 3535 7716 54.2

% taking

part in

D2S

Number of children examined, attending

school which is now

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Figure 11 Mean dmft for children attending primary schools by participation in Designed to Smile, 2007/08 – 2014/15

Figure 12 % dmft>0 for children attending primary schools by participation in Designed to Smile, 2007/08 – 2014/15

Additional Information

Data from previous Welsh surveys is available from the Welsh Oral Health Information Unit

website.


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Appendix 1 – Mean dmft trends by Unitary Authority, 2007/08 to 2014/15

Figure 13 North Wales – Mean dmft trends by Unitary Authority, 2007/08 to

2014/15

Figure 14 Mid and West Wales – Mean dmft trends by Unitary Authority,

2007/08 to 2014/15

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Figure 15 South East Wales – Mean dmft trends by Unitary Authority, 2007/08

to 2014/15

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Appendix 2 Key Dental Caries Variables from the Survey of 5 year olds

2014/15

LHB UA mean dmft %dmft>0

mean dmft of

those with caries

expereince

mean dt

Aneurin Bevan Blaenau Gwent 2.33 52.3 4.46 1.79

Aneurin Bevan Caerphilly 1.51 42.3 3.58 1.07

Aneurin Bevan Monmouthshire 1.14 32.4 3.51 0.85

Aneurin Bevan Newport 1.64 41.6 3.94 1.08

Aneurin Bevan Torfaen 1.65 42.0 3.94 1.33

Abertawe Bro Morgannwg Bridgend 1.61 46.2 3.49 1.01

Abertawe Bro Morgannwg Neath Port Talbot 1.36 39.6 3.44 0.86

Abertawe Bro Morgannwg Swansea 1.64 43.9 3.74 1.18

Betsi Cadwaladr Anglesey 1.38 44.2 3.13 1.14

Betsi Cadwaladr Conwy 1.01 29.3 3.44 0.75

Betsi Cadwaladr Denbighshire 1.31 35.9 3.65 1.13

Betsi Cadwaladr Flintshire 1.06 32.5 3.26 0.74

Betsi Cadwaladr Gwynedd 1.03 33.8 3.06 0.69

Betsi Cadwaladr Wrexham 0.89 24.1 3.70 0.65

Cardiff and Vale Cardiff 1.00 26.7 3.74 0.65

Cardiff and Vale Vale of Glamorgan 0.70 20.2 3.45 0.42

Cwm Taf Merthyr Tydfil 2.59 58.6 4.43 1.32

Cwm Taf Rhondda Cynon Taff 1.54 43.1 3.58 0.81

Hywel Dda Carmarthenshire 0.83 25.6 3.25 0.53

Hywel Dda Ceredigion 0.76 22.8 3.35 0.60

Hywel Dda Pembrokeshire 1.05 30.9 3.39 0.80

Powys Powys 1.15 31.8 3.61 0.91

1.55 43.3 3.59 1.041.62 41.9 3.86 1.171.08 31.9 3.39 0.810.92 24.9 3.68 0.591.77 46.3 3.81 0.920.90 27.0 3.32 0.631.15 31.8 3.61 0.91

1.29 35.4 3.63 0.88

POWYS

WALES

ABERTAWE BRO MORGANNWGANEURIN BEVANBETSI CADWALADRCARDIFF AND VALECWM TAFHYWEL DDA

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2011/12


mean dmft of

those with caries

expereince

mean dt






















Powys Powys 1.25 34.8 3.60 0.90

1.64 44.2 3.72 1.212.01 46.4 4.34 1.451.41 40.4 3.49 0.921.41 34.7 4.07 0.921.89 50.7 3.72 1.111.21 33.1 3.66 0.821.25 34.8 3.60 0.90

1.59 41.4 3.85 1.08

POWYS

WALES


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2007/08


mean dmft of

those with caries

expereince

mean dt






















Powys Powys 1.60 38.9 4.12 1.24

2.14 48.5 4.41 1.432.38 54.8 4.35 1.781.64 43.4 3.76 1.121.45 38.9 3.73 0.901.89 47.1 4.02 1.122.00 47.4 4.22 1.551.60 38.9 4.12 1.24

1.98 47.6 4.16 1.40

POWYS

WALES


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Appendix 5 Interpretation of historical survey data

This document on the NHS dental survey programme in Wales is the third produced since

changes had to be made to the consent arrangements for dental examination of school year

1 children (approximately 5-year-old) requiring formal written parental consent.

Data collected before 2006 cannot be compared with data collected from 2007/08. The bias

introduced by the changed consent arrangements will never be fully understood because

children were not examined if parental consent was not provided.

Decay levels generated from surveys of this age group are recognised as an underestimation

of the true experience for three main reasons:

1. Missing deciduous incisors are not included in these calculations because in a few

children they may have naturally exfoliated by age 5. All missing incisors are

assumed to have been naturally exfoliated although some will in fact have been

extracted. Thus the reported decay levels at age 5 are always a slight

underestimation of the true decay experience of those children examined in a

survey.

2. These surveys employ a visual examination of the child’s mouth, no radiographs are

taken. This is another factor which means that reported decay levels underestimate

the true disease level.

3. Furthermore, previous research suggests that children who do not participate in the

dental surveys are likely to have more decay than those participating,

Thus the mean decay levels in children reported here and in the two previous surveys are

likely to slightly under estimate the true decay experience of children aged 5 in Wales.

These underestimates are likely to be present in all three surveys since 2007 to similar

degrees. As a result the trends reported by comparison across these surveys will provide a

realist picture of changes in decay experience.

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PICTURE OF ORAL HEALTH 2016 - Cardiff University€¦ · ©Cardiff University, February 2016 . 3 Summary The 2014/15 dental survey of five year olds shows a further 6% reduction in